Home parenteral nutrition with early referral improves survival

Nearly all children with primary digestive disease receiving home parenteral nutrition survive if referred early to an expert center, finds the latest Journal of Pediatric Gastroenterology & Nutrition.

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More information is needed regarding the prognosis of children receiving home parenteral nutrition.

Dr Virginie Colomb and colleagues described 20-year outcome data in children receiving home parenteral nutrition in a single pediatric home parenteral nutrition center.

The investigative team provided separate profiles for the major pediatric diagnostic subgroups.

The team evaluated 302 children who started receiving home parenteral nutrition between 1980, and 1999.

Survival probabilities at 10 years were 81%

Journal of Pediatric Gastroenterology & Nutrition

Of the children recruited, 76% had primary digestive disorders and 24% had nonprimary digestive disorders.

The median age at home parenteral nutrition onset was 2 years.

The investigators noted that the median duration of home parenteral nutrition was 1 year.

By 2000, the investigators observed that 54% had weaned from home parenteral nutrition.

The team found that 26% were still receiving home parenteral nutrition, 16% had died, and 4% had undergone intestinal transplantation.

The investigators found the survival probabilities at 2, 5, 10, and 15 years were 97%, 89%, 81%, and 72%, respectively.

The likelihood and cause of death depended on the underlying diagnosis.

The team noted that 9% of children with primary digestive disorders died.

Of these, 24% died from their primary disease, and 48% from liver disease or sepsis.

Children with intractable diarrhea of infancy had the highest mortality rate at 25%.

The team observed that children with intractable diarrhea also had the highest incidence of liver disease, occurring in 48%.

The team noted that 38% of children with primary nondigestive diseases died.

Of these, 94% died from their primary disease and 6% from liver disease or sepsis.

Dr Colomb's team concluded, “Outcomes and survival of children receiving home parenteral nutrition are mainly determined by their underlying diagnosis.”

“Nearly all children with primary digestive disease survive if referred early to an expert center.”